Methotrexate For Rheumatoid Arthritis: Is It Safe And How Does It Work
Methotrexate is a medication thats often used to treat rheumatoid arthritis , which can cause symptoms like red, painful, and swollen joints. If youve heard of methotrexate before, you probably already know its a medication thats taken long term to help lessen the symptoms of RA. But what about side effects? And how does it compare to other medications? Heres what you should know about this popular medication and why its still considered to be the first choice among rheumatoid arthritis treatments.
What Is Arthritis Why You Should Worry About It
What scares you about old age the most? For most of us, it is the fact that we would lose our vitality and speed.
Such pain and disability is caused due to progressive joint conditions which are categorized as arthritis .
Rheumatoid arthritis it is a painful degenerative disorder of the joints in which the joints become inflamed and cause a lot of pain. The person is unable to walk freely. There may be tenderness and swelling of the joints. Most common site for arthritis are the knees and fingers. But any joint can get affected without an exception.
If you have arthritis, you know that it can have a debilitating effect on you, and may even restrict your movement to a large extent.
Fortunately, the age old science of Ayurveda has some treatment options which offer relief for arthritis.
Things To Know Before You Start
Azathioprine is a very effective drug for many patients with arthritis. But its not suitable for everyone.
Before prescribing azathioprine, your doctor will order a blood test for an enzyme called TPMT, also known as thiopurine methyltransferase . Enzymes are proteins in your body that can help to break down certain substances or chemicals.
TPMT helps to break down and remove azathioprine from the body. Low levels of TPMT may mean there is a slightly increased risk of side effects from azathioprine, so your doctor may suggest a lower dose.
If the TPMT result is very low, azathioprine may not be the right medication for you, and your doctor will discuss other treatment options.
Azathioprine may need to be used with caution if:
- you have severe liver or kidney problems
- you have bone marrow problems
- you have infections that repeatedly come and go.
Before starting azathioprine you might need to be checked for previous hepatitis B or C infections, as this drug can increase the risk of these infections starting up again. If the tests are positive you may need antiviral treatment first.
Youll also need to have a chest x-ray before starting azathioprine. If you have any long-term lung conditions, such as fibrosis or emphysema, youll need tests to see how your lungs are working to check whether azathioprine is suitable for you.
If you smoke, its worth cutting down or ideally giving up, as smoking increases the risk of complications of your condition and its treatments.
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Nutritional Supplements And Dietary Changes
There’s no strong evidence to suggest that specific dietary changes can improve rheumatoid arthritis, although some people with rheumatoid arthritis feel their symptoms get worse after they have eaten certain foods.
If you think this may be the case for you, it may be useful to try avoiding problematic foods for a few weeks to see if your symptoms improve.
But it’s important to ensure your overall diet is still healthy and balanced. A Mediterranean-style diet, which is based on vegetables, fruits, legumes, nuts, beans, cereals, grains, fish and unsaturated fats such as olive oil, is recommended.
There’s also little evidence supporting the use of supplements in rheumatoid arthritis, although some can be useful in preventing side effects of medicines you may be taking.
For example, calcium and vitamin D supplements may help prevent osteoporosis if you’re taking steroids, and folic acid supplements may help prevent some of the side effects of methotrexate.
There’s some evidence to suggest that taking fish oil supplements may help reduce joint pain and stiffness caused by rheumatoid arthritis.
Further information
- National Rheumatoid Arthritis Society : diet and rheumatoid arthritis
Page last reviewed: 28 August 2019 Next review due: 28 August 2022
How Will My Doctor Choose Drugs That Are Right For Me
Your doctor will work with you to develop a treatment program. The drugs your doctor prescribes will match the seriousness of your condition.
Your doctor will combine the results of your medical history, physical exam, X-rays and blood tests to create your treatment program. The doctor will also consider your age, sex, physical activity, other medications you are taking and any other medical conditions you may have.
It is important to meet with your doctor regularly so that he or she can closely monitor you for any side effects and change your treatment, if necessary. Your doctor may periodically order blood tests or other tests to determine the effectiveness of your treatment and any side effects.
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Important Safety Information & Use
Warning: Serious Infections, Cancer, and Blood Clots
RINVOQ is a medicine that can lower the ability of your immune system to fight infections. You should not start taking RINVOQ if you have any kind of infection unless your healthcare provider
USEUSE for RINVOQ
RINVOQ is a prescription medicine used to treat adults with moderate to severe rheumatoid arthritis in whom methotrexate did not work well or could not be tolerated. It is not known if RINVOQ is safe and effective in children under 18 years of age.
IMPORTANT SAFETY INFORMATION about RINVOQ
What is the most important information I should know about RINVOQ?
RINVOQ is a medicine that can lower the ability of your immune system to fight infections. You should not start taking RINVOQ if you have any kind of infection unless your healthcare provider tells you it is okay.
What should I tell my HCP BEFORE starting RINVOQ?
Tell your HCP if you:
- Are being treated for an infection, have an infection that wont go away or keeps coming back, or have symptoms of an infection such as:
- – Fever, sweating, or chills
- – Warm, red, or painful skin or sores on your body
- – Muscle aches
Best Overall: Biofreeze Professional Pain Relief Spray
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Fragranced
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Extra-thick consistency, so it takes longer to rub in
Although you can certainly use Sportscreme in situations where exercise or movement wasnt involved, it is a good option for those with arthritis who may have overdone it on a particular day with walking, housework, gardening, or other activities. Or, if youre doing something that you anticipate will leave you sore, you can also use the product ahead of time. Sportscremes clean fresh scent is polarizing: some find it pleasant, while others would prefer a product with no scent at all.
Active Ingredients: Trolamine salicylate | Dose: Apply generously to the affected area. Massage into painful areas until thoroughly absorbed into skin. Repeat as necessary, but not more than 4 times daily. | Uses: Temporary relief of minor aches and pains
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Fertility Pregnancy And Breastfeeding
If youre planning to try for a baby, if you become pregnant, or if youre thinking of breastfeeding, we suggest you discuss your medications with your rheumatologist.
Current guidelines suggest that its fine for men and women to take adalimumab when trying for a baby.
Women can also take adalimumab in the first six months of pregnancy.
Youll usually be advised to come off adalimumab in the last three months of pregnancy so that your baby can have a normal vaccination schedule at birth. But if your arthritis is bad, you might be advised to take adalimumab throughout your entire pregnancy. If you do, then your baby should not have any live vaccines, such as a BCG, until theyre seven months old.
You should be OK to breastfeed while taking adalimumab, but the research is limited so it would be a good idea to talk to your doctor about this.
If youre on methotrexate as well as adalimumab, you should stop taking methotrexate, and use contraception for at least three months before trying to become pregnant. You mustnt take methotrexate if youre pregnant or breastfeeding. But its fine for men to take methotrexate when trying to father a baby.
What Are The Symptoms Of Rheumatoid Arthritis
The main symptoms of RA are joint pain, swelling, and stiffness. Usually, symptoms develop gradually over several weeks, but in some people, symptoms develop rapidly.
The small joints of the hand and feet are usually the first to become affected. Stiffness is usually worse first thing in the morning or after periods of inactivity and may make movement difficult. RA usually affects the joints on both sides of the body equally.
The pain is typically described as throbbing and aching. Joint stiffness is usually worse in the morning but still tends to persist, unlike stiffness caused by osteoarthritis which tends to wear off after about 30 minutes. Because the tissue inside the joints is affected, joints may look swollen and feel hot and tender to the touch. Some people develop firm swellings under the skin, called nodules, around affected joints.Joint and bone destruction can occur over time if the disease process is not well-controlled.
Patients may also lack energy and have experience fevers, sweating, a poor appetite, and weight loss. Other symptoms may occur depending on what other parts of the body are affected, for example, dry eyes, or heart or lung problems.
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What Are The Potential Risks And Benefits Of Injectable Medications For Rheumatoid Arthritis
Biologic agents used to treat RA need to be injected. The biggest benefit of these drugs is that they are very effective.
- Biologics not only relieve symptoms but also halt damage to joints and generally provide quick relief.
- The biggest drawback of biological agents is cost. Patients can spend thousands of dollars a month using biologics.
- Other drawbacks include side effects, which may be severe because biologics suppress the immune system, enhancing the possibility of infections.
- In addition, patients may not like receiving injections.
How Do I Take Methotrexate
Methotrexate is typically taken once a week for RA. It is available as both a tablet you take by mouth and as an injection. With the tablets, most people start with one 7.5 mg dose once a week, but your provider may recommend up to a maximum dose of 25 mg once a week depending on how you respond. To reduce the risk of side effects, they may ask you to split the dose into smaller doses that you take throughout the day of the week youre scheduled to take your medication.
If youre using the injection, thats once a week, too. Youll inject the medication either into your muscle or right under your skin, depending on what your provider recommends. The injection is available as either an auto-injector or as a vial. You can find instructions on how to use Rasuvo from the manufacturer here.
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How Is It Taken
Amitriptyline can be prescribed as a tablet or liquid. Youll need to take it every day an hour or two before your usual bedtime, as it can make you sleepy. If you find youre still feeling sleepy when you wake in the morning, try taking it earlier in the evening.
Amitriptyline is taken at lower doses for pain relief than when it’s used for depression. Your doctor will usually start you on the lowest dose possible and may increase it if you’re still experiencing pain after several weeks. Doses for children aged under 12 are worked out according to their weight and symptoms. It can take up to six weeks for you to see the benefits, so try to stick with it.
Youll probably take it for as long as it helps your condition. Some people take it for many months, even years, without having any negative effects.
It isnt an addictive medication, but you may get unpleasant side effects if you suddenly stop taking it. You should talk to your doctor before making any changes to your treatment. Theyll probably recommend that you reduce the dose slowly over several weeks or more, depending on how long youve been taking it.
Where To Buy Lab Grade Products
There are a lot of extremely inferior products on the market. Still worse, many of the cheap herbal supplements found in Amazon.com and on the shelves of local drugstores are not inspected by third party regulators with FDA oversight. The majority are selling weakly concentrated ingredients, and there is growing concern that many products are testing in the danger zone for toxic chemicals and fillers.
Below are two companies that weve tested and found to produce lab grade turmeric and boswellia serrata. Their cost is higher due to the quality of ingredients and their strict self-imposed testing standards. Still, the cost is small compared to prices of pharmaceuticals.
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What Is Rheumatoid Arthritis
Arthritis is a general term that describes inflammation in joints. Rheumatoid arthritis is a type of chronic arthritis that occurs generally in joints symmetrically . This involvement of several joints helps distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect the skin, eyes, lungs, heart, blood, nerves or kidneys.
How Long Does It Take To Start Working
While everyone will have a different experience with methotrexate, research suggests that some people will notice improvements within 3 months of starting the medication. For some people, it may take longer. Your provider will likely ask you to get a lab test every 2 to 4 weeks over this time period to monitor the levels of methotrexate in your body and make sure you can continue safely taking it.
Its important that you dont stop taking methotrexate unless your provider tells you to. Your arthritis symptoms may return and they may even be worse than before. After about 6 months, your provider will likely reevaluate your treatment plan if your symptoms have not improved. The next step might be trying a combination of methotrexate with another medication.
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New Oral Treatment For Rheumatoid Arthritis
Olumiant to reduce inflammation and other symptoms
The European Medicines Agency has recommended granting a in the European Union for Olumiant for the treatment of adults with moderate to severe active rheumatoid arthritis. It is to be used to treat patients who have not responded adequately to, or who are unable to tolerate one or more diseasemodifying anti-rheumatic drugs . Olumiant, which is taken by mouth, can be used on its own or in combination with methotrexate.
Rheumatoid arthritis is an immune system disease causing inflammation and damage in the joints. It affects between 0.5% and 1% of people in the EU. Patients with moderate to severe rheumatoid arthritis have chronic inflammation causing fatigue, pain and joint stiffness. While the symptoms are reversible with appropriate treatment, joint damage and the associated disability are permanent.
Patients with rheumatoid arthritis are treated with medicines called DMARDs, most commonly the oral treatment methotrexate on its own, or in combination with another DMARD which is given by injection or infusion. However, even with the most effective treatments available, more than half of patients do not achieve a satisfactory response. Therefore, new treatment options are needed.
Maintenance of efficacy was demonstrated in 52-week-long trials. Olumiant showed efficacy in patients who had not responded to biologic DMARDs as well as in patients that had never been treated before.
Note:
General Approach To Drug Therapy
Drug therapy is just one component in the treatment of rheumatoid arthritis, which also includes non-pharmacological treatments such as physiotherapy and exercises. All patients should be instructed in the self-adjustment of simple analgesics and anti-inflammatory drugs as these complement therapy with slow-acting disease-modifying anti-rheumatic drugs . The DMARDs are no longer withheld until radiographic joint erosions develop. They are now introduced at the diagnosis of rheumatoid arthritis, aiming at quick eradication of inflammation. It is important as their efficacy is greatest early in the course of the disease. Response to therapy with a single DMARD is often suboptimal and trials have found that combination therapy with methotrexate, sulfasalazine and hydroxychloroquine can be more effective. 2
In Australia the first choices for rheumatoid arthritis treatment are methotrexate, sulfasalazine and leflunomide . They are usually begun as individual drugs or in combination with hydroxychloroquine. Their efficacy is similar so the choice of drug often relates to cost and restrictions under the Pharmaceutical Benefits Scheme , or to avoidance of adverse events secondary to alcohol consumption, sulfa allergies, or lack of contraception.
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Other Immunomodulatory And Cytotoxic Agents
Some additional immunomodulatory drugs are used in RA including azathioprine , and cyclosporin A . Rarely cyclophosphamide and d-Penicillamine are used. Because the potential of high toxicity, these agents are typically utilized for life-threatening extra-articular manifestations of RA such as systemic vasculitis or with severe articular disease that is refractory to other therapy.
Azathioprine has some activity in rheumatoid arthritis but may take 8-12 weeks to see an effect. It is a purine analog that can cause bone marrow suppression and lowering of blood cell counts particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors. Increased risk of secondary malignancy due to azathioprine is controversial. Screening for levels of the enzyme thiopurine methyltransferase is recommended before initiating therapy with azathioprine. Certain individuals have deficiencies in this enzyme that metabolizes azathioprine with a concomitantly increased risk of toxicitiy for the medication. Side effects include nausea, and alopecia. Blood tests to monitor blood counts and liver function tests are necessary for patients on azathioprine.